Evaluation of Upper-Limb Feeding Performance Using the Fugl–Meyer Assessment

PURPOSE: Upper-limb paralysis due to cerebrovascular disease strongly affects feeding (Miyamoto, Kondo, Suzukamo, Michimata, & Izumi, 2009). Accurate estimation of upper-limb function is important to clarify feeding ability. In a previous study, Fugl–Meyer Assessment (FMA) scores were shown to correlate with ability to perform activities of daily living (ADLs; Hsieh et al., 2009). However, because upper-limb feeding performance evaluation using FMA scores remains unclear, this study aimed to determine optimal FMA cutoff values for upper-limb feeding performance evaluation.

DESIGN: Cerebrovascular disease patients who were age ≥20 yr and who were admitted to Takeda General Hospital and prescribed rehabilitation participated in this cross-sectional study.

METHOD: FMA administration and upper-limb feeding performance evaluation were conducted between April and September 2015. Out of 168 cerebrovascular disease patients who were admitted to Takeda General Hospital and prescribed rehabilitation, 125 were excluded because of refusal to participate, worsening of symptoms, another disease that needed treatment, or paralysis of the nondominant hand. The final analysis included 43 patients.

The FMA is one of the most widely used quantitative measures of motor impairment for poststroke patients. The upper-limb feeding performance of the dominant hand was divided into the following three categories: “cannot use spoon,” “can use spoon,” and “can use chopsticks.” The FMA sensitivity and specificity as indicators of upper-limb feeding performance categories with cutoff values were determined. Receiver operating characteristic (ROC) curves were plotted to determine the cutoff values. The optimal cutoff values were defined as the point at which sensitivity + specificity − 1 was maximum (Youden index; Perkins & Schisterman, 2006). ROC analysis was performed using IBM SPSS Statistics Version 19.0. The study protocol was reviewed and approved by the Ethics Committee of Tohoku Fukushi University and Takeda General Hospital.

RESULTS: This study included 24 men and 19 women. The mean age was 79.2 ± 12.1 yr (age range = 48–99 yr). Among the 43 enrolled patients, 28 (65.1%) were in the “cannot use spoon,” seven (16.3%) were in the “can use spoon,” and eight (18.6%) were in the “can use chopsticks” groups. The mean FMA values were 14.9 ± 16.3 for “cannot use spoon,” 50.4 ± 14.1 for “can use spoon,” and 64.6 ± 15.1 for “can use chopsticks.” The ROC areas under the curves were 0.97 (95% confidence interval [CI] [0.93, 1.00]) and 0.99 (95% CI [0.96, 1.00]) for FMA scores as indicators of “can use spoon” and “can use chopsticks,” respectively. The cutoff value for “can use spoon” was 54/53 points (maximum Youden index = 0.831), with a sensitivity and specificity of 86.7% and 96.4%, respectively. The cutoff value for “can use chopsticks” was 62/61 points (maximum Youden index = 0.971), with a sensitivity and specificity of 100.0% and 97.1%, respectively.

CONCLUSION: In this study, we determined the optimal FMA cutoff values for upper-limb feeding performance evaluation. Previously, upper-limb performance in cerebrovascular disease patients was mainly evaluated by dexterity based on functional abilities such as grasp, grip, pinch, and gross movement (Kwakkel, Kollen, van der Grond, & Prevo, 2003). A Japanese study evaluated upper-limb functional use in ADLs such as using chopsticks (Ueda & Okawa, 1996). Our optimal FMA cutoff scores may be able to identify upper-limb feeding performance in cerebrovascular disease patients.

References

Hsieh, Y. W., Wu, C. Y., Lin, K. C., Chang, Y. F., Chen, C. L., & Liu, J. S. (2009). Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation. Stroke, 40, 1386–1391. https://doi.org/10.1161/STROKEAHA.108.530584

Kwakkel, G., Kollen, B. J., van der Grond, J., & Prevo, A. J. (2003). Probability of regaining dexterity in the flaccid upper limb: Impact of severity of paresis and time since onset in acute stroke. Stroke, 34, 2181–2186. https://doi.org/10.1161/01.STR.0000087172.16305.CD

Miyamoto, S., Kondo, T., Suzukamo, Y., Michimata, A., & Izumi, S. (2009). Reliability and validity of the Manual Function Test in patients with stroke. American Journal of Physical Medicine and Rehabilitation, 88, 247–255. https://doi.org/10.1097/PHM.0b013e3181951133

Perkins, N. J., & Schisterman, E. F. (2006). The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. American Journal of Epidemiology, 163, 670–675. https://doi.org/10.1093/aje/kwj063

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